- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,023.77 / $16,648.30 / $22,332.30
| Facility | | $8,023.77 | $16,648.30 | $22,332.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,957.44 / $32,957.44 / $32,957.44
| Facility | | $32,957.44 | $32,957.44 | $32,957.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,897.00 / $12,370.83 / $14,709.50
| Facility | | $3,897.00 | $12,370.83 | $14,709.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,151.07 / $17,191.20 / $27,058.42
| Facility | | $14,151.07 | $17,191.20 | $27,058.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $21,239.28 / $26,823.70
| Facility | | $1,350.00 | $21,239.28 | $26,823.70 |